Public Whip Count

March 01, 2010

Posted by: Chris

More sobering news that the retrovirus that causes AIDS has itself gone retro, impacting much gay men in percentages that rival the disease's devastation in sub-Saharan Africa:

In several U.S. urban areas, the HIV prevalence among men who have sex with men is as high as 30%—as compared with a general-population prevalence of 7.8% in Kenya and 16.9% in South Africa.

The reason, according to research in the New England Journal of Medicine, is that the epidemic is "generalized" among African populations, but not so here in the U.S., where it's not just concentrated geographically but within particular social networks.

That's led to a rethinking of HIV prevention efforts, which for years have focused on specific high-risk transmission behaviors, like unprotected sex, IV drug use, promiscuity and the like. We've all heard that, among gay men in particular, "the use of drugs such as crystal methamphetamine — especially at sex parties and in venues such
as bathhouses — has contributed to risky behavior and HIV acquisition."

But now AIDS researchers are, in some senses, going back to where they started, looking at whether the strongest indicator of whether a person is at high risk of being infected is his "social-sexual network," especially in big cities in the Northeast and West Coast, as well as the South.

The extent of the risk of acquiring HIV in the United States today is largely defined by a person's sexual network rather than his or her individual behaviors. Understanding the context and settings in which risk is increased may lead to more robust and effective preventive interventions.

For example, black men who have sex with men are at increased risk for HIV infection in part because of its high prevalence in their sexual networks and their likelihood of choosing racially similar partners; they have also been shown to be less likely than their white counterparts to be aware of their HIV status and thus are more likely to unknowingly transmit HIV. Moreover, even those who are aware of their HIV infection may be less engaged in HIV care and less likely to avail themselves of antiretroviral therapy — behavior that limits the potential benefit of such therapy as a preventive strategy. …

Research is also needed to identify interventions that will persuade men who have sex with men to undergo HIV testing, facilitate their disclosure of their HIV status to sexual partners, and promote negotiations for safer sexual practices; such interventions need to be implemented in the settings where such men may meet (e.g., in bars or on the Internet).

More research, yes. But while we wait for more data, the time is now for the government and the non-profit groups that make up AIDS, Inc., and Gay, Inc., to launch aggressive new prevention campaigns that meet gay men where they are, and give them the information they need to lower their risk of infection.

Enough with the tired safe-sex messages that the younger set especially stopped listening to long ago. Handing out condoms in bars won't cut it anymore. What we need are creative prevention campaigns that are deployed on the social networks like Facebook, Twitter and the sites where gay men meet to hook up -- from Manhunt to Adam4Adam to Craigslist.

February 22, 2010

Posted by: Chris

If you are a sexually active gay man, or if you know someone who is, then you need to know about a just released study that raises some findings that challenge the current conventional wisdom about safer sex:

The introduction of effective drugs against HIV, the virus that causes AIDS, has not changed gay men's risk of contracting the virus during a single act of anal sex, new research from Australia shows.

This finding was "unexpected," the study's authors admit, given that treatment with AIDS drugs sharply reduces the concentration of HIV in a person's blood, which would theoretically make it more difficult to transmit the virus.

It's been accepted wisdom among gay men and our doctors ever since the early successes of the "AIDS cocktail" of retroviral drugs that reducing the viral load in the bloodstream and other bodily fluids of those with HIV would also reduce dramatically the risk that they could infect others. At least according to this new study, that assumption was false.

The riskiest type of sexual activity was receptive anal sex with ejaculation into the rectum; each such act carried a 1.43 percent risk of contracting HIV. If a man's partner withdrew before ejaculation, the risk dropped to 0.65 percent. Circumcised men had a 0.11 percent risk of contracting HIV for every insertive sex act, while the risk for circumcised men was 0.62 percent.

The findings are "very similar" to a US study done in the early 1990s, the researchers note, which found an 0.82 percent risk of contracting HIV for every instance of receptive anal sex (whether or not withdrawal occurred).

I tried for years when I edited the Washington Blade and a number of other gay publications to get this kind of straightforward info about the risk associated with various sexual acts, both as the active ("top") or passive ("bottom") partner. We were, for the most part, stonewalled by public health "experts" who were loathe to trust gay men with actual info, favoring instead the tired "AIDS panic" approach of trying to scare men into using condoms by implying that any sort of sex was equally risky.

The results of the Aussie study are surprising because rates of HIV testing among gay men there are high (70%), of the HIV viral load is "undetectable" in three-quarters of those under treatment. And yet the risk of exposure appears not to have changed from the '90s, when almost no HIV-positive men had "undetectable" amounts of HIV in their bodies.

The study's authors warned that "caution should be exercised before interpreting the results at the level of individual men," but the take-away here seems clear

If you are HIV positive, you owe it to others to always always always wear a condom every time you top, unless you are sure than your partner is also HIV positive. No rationalizations like "he should ask if he wants to know"; no excuses like "I'm undetectable so sex with me is safe."

If you are HIV negative, you should never never never allow someone to top you without a condom, no matter what you may think about their HIV status or whether they are on the cocktail and seem healthy. There is still no cure for AIDS or reliable information about the long-term harm from HIV meds. It's not worth the risk.

Finally, it's way past time for the panoply of organizations that make up AIDS, Inc., having received millions in public and private funding to educate gay men and others about the risks of transmission, to disseminate specific information like this so that each of us can make responsible choices about our sexual conduct.

June 08, 2009

Posted by: Chris

I had to smile when I read a post welcoming me back to blogging from a somewhat unlikely source: Michael Petrelis. It was something of an understatement for Michael, a longtime gay, AIDS and human rights activist, to write that we have had "a sometimes adversarial acquaintance over the years."

During my tenure editing Southern Voice in Atlanta, the Washington Blade and the other publications in the Window Media family, Petrelis left me his share of screaming voice mails. He was usually complaining about our decision not to give what he considered adequate coverage to a story or, more frequently, to source stories from outside the usual Beltway suspects.

He was a pain in the ass, frankly, to me and my reporters, but then again, that's what the long lost art of activism is all about. I still differ with him on his methods at times, as well as on substance occasionally, but then and now Michael was at times spot-on in his criticism. I particularly took to heart his complaint that we should never do a story about HIV/AIDS without at least one quote from someone living with the disease, and I worked with the reporters to make it something of a rule for our coverage.

Anyway, Michael has long been an ally -- along with Andrew Sullivan, the Gay Patriot folks and my co-blogger Kevin -- about the massive waste of potential and resources that is the Human Rights Campaign. It was on this point that Michael welcomed me back to blogging. And I have to say, thanks Micchael, it's good to be back.

January 15, 2009

Posted by: Chris

Asked how his presidency will be remembered, George W. Bush famously
said, “You never know what your history is going to be like until long
after you’re gone.”

We can chuckle all we want at Bush-isms
like that one, but we needn’t wait “until long after we’re gone” to
know that on issues important to gay and lesbian Americans, history
will judge Bush unkindly.

The Texas governor and son of an
ex-president campaigned as a “compassionate conservative,” but the
contested election of 2000 made it almost impossible for Bush 43 to
deliver on his promise to be “a uniter, not a divider.” He would
squander his second chance to unite the country, after the horrific
attacks of Sept. 11, 2001.

The Iraq War again divided the country
and re-election prospects were looking grim, but the landmark gay
marriage ruling in Massachusetts presented Bush the perfect political
opportunity to follow the cynical divide and conquer “strategery” of
his political “brain,” Karl Rove. In the January 2004 State of the
Union address, a speech itself mandated by the Constitution, Bush
signaled his support for amending the nation’s founding document to ban
gay marriage.

In one of many cruel ironies from the Bush years,
W. used the “G word” for the first time as president during that 2004
campaign, while reassuring a voter that he would do everything within
his power to save “traditional marriage.”

Sadly, the wedge
politics worked even if the federal amendment never came close to
passing. Across the nation, Republican politicians responded to the
president’s call by proposing state constitutional amendments to ban
gay marriage. The resulting ballot measures brought conservatives to
the polls in November, tipping battleground states like Ohio for Bush
and ensuring a second term.

Even in the waning months of his
presidency last year, Bush reached out to remind gay Americans that we
were second-class citizens. His White House staff threatened to veto
the most basic gay rights legislation: a hate crime bill and the
Employment Non-Discrimination Act.

There were some indications
that ENDA amendments agreed to in the House, stripping gender identity
protections and strengthening exceptions for faith-based employers,
might have resulted in the president actually signing the legislation.
Perhaps for that reason, as well as the divisive fight over transgender
protections, the Democratic-controlled Senate never took up ENDA, and
President Bush was never forced to decide whether to sign or veto.

The
stormy Bush legacy on gay issues has a few silver linings. Some
controversial executive orders ping-pong between presidents of
different parties, signed by one only to be repealed by the next. Bush
left in place a Clinton-era order that protected federal workers
against anti-gay discrimination. But Bush did little when one of his
own appointee watered down the protections until they were effectively
meaningless.

Bush was the first GOP president to send openly gay
nominees to the Senate for confirmation. During the Clinton years,
appointees like Roberta Achtenberg and James Hormel faced stiff
resistance from Republicans like Jesse Helms based solely on their
sexual orientation. Although Bush made precious few out gay
appointments, his willingness to do so at all marked an end to the
Helms era even before Helms himself passed away.

Another Bush
highlight was his massive commitment to the fight against AIDS outside
the U.S., especially in Africa. Without taking anything away from that
effort, it was hard not to see it as a signal that the heterosexual
population affected by AIDS in Africa was more sympathetic to the
president that the largely homosexual population here at home.

Because
on the domestic AIDS front, Bush reverted to the Reagan-Bush policy of
malign neglect, setting policy with almost total disregard for the
health of gay and bisexual Americans, who remained at the greatest risk
of contracting HIV.

HIV prevention policy under Bush emphasized
abstinence only until marriage, ignoring the cruel irony that this same
administration was actively working to prevent gays from marrying. Did
he really expect gay men to abstain from sex our entire lives?

It
wasn’t just in AIDS policy that W. treated us not just as second class
citizens of this country, but worse even than foreigners. In yet
another irony, this additional smack in the face came from a regulation
that may actually mark the first time the U.S. government recognized
same-sex relationships, and in immigration of all areas.

Foreigners
who come to America on work visas are permitted to bring their
unmarried partners with them, and the Bush administration decided that
regulation includes same-sex partners as well. The motivation was not
gay rights but competitiveness, since U.S. employers would otherwise
lose out on talented young Europeans who are marrying later or entering
into civil unions.

As positive as this recognition was, it only
highlighted how gay and lesbian Americans now have even less rights
than non-Americans to sponsor foreign same-sex partners to live in the
United States.

It will take months if not years for the incoming
administration and Congress to undo the harm done in eight years of
George W. Bush, not to mention his Democratic predecessor. For that
reason alone, Jan. 20 can’t come soon enough.

September 12, 2008

Posted by: Kevin

The growing raft of statistics is proving what many have been yelling about for years: the HIV/AIDS epidemic in the United States is far from over, but in fact it is gathering strength in the wake of our government's lagging and inefficient response.

Yesterday, the Centers for Disease Control issued a report that is more detailed than ever about precisely where new infections are happening. As expected, particularly for local and state AIDS service organizations, the disease continues apace among men who have sex with men, and is disproportionately exploding among blacks and latinos. (The report is here.)

But between the lines is yet another indication of where the U.S. is falling dangerously behind on a number of policy fronts -- a giant portion of those infected today (between 25% and 28%) don't know they have HIV, and a great number of them will unknowingly infect others and only enter treatment later than they should. This is horrifying, and it isn't news to any AIDS service organization in major cities or especially the rural South. Also, as much as 80% of gay and bisexual men in 15 cities have not been reached by HIV prevention efforts that have been proven effective.

In short - at a time where no other country is doing more in the global fight against AIDS, America has been slow to react to shifting factors at home, and has abandoned the fight by default. For the gay community, which spent so much of its blood and treasure, and lost nearly a whole generation in the first half of this epidemic, this should be the most outrageous and galling information to emerge yet in this political year.

In July of this year, Kai Wright wrote an excellent and incisive piece for The American Prospect which described the creeping "AIDS apartheid" that has unfolded over the past several years. He shows how it is due to the inertia in shifting our national HIV/AIDS policies to get in front of the changing face of this epidemic. The American South has become an HIV/AIDS "ground zero" because of outdated, clanking federal policies on routine HIV testing, on funding through the Ryan White CARE Act (that is still far too tied to formulas shaped for the epidemic of 1990), and the gross abdication of effective prevention efforts of any kind where they are needed the most. And Wright correctly concludes that "(w)hatever is causing the racial disparity in infection rates, it is
ultimately going to collapse the system we built to make AIDS care
accessible in the United States."

Wright joins the growing voices in favor of a U.S. national HIV/AIDS strategy. It is amazing, but we have never had one. As a pre-requisite of receiving money from President Bush's ground-breaking multi-billion dollar global AIDS program, countries with a tiny fraction of our GDP must have a national HIV/AIDS strategy, with targets and goals spread out over increments of 1-5 years, and must have a national AIDS director that is accountable for them. And yet, astoundingly, the United States has never done the same.

Our national response since the advent of the Ryan White CARE Act in 1990 has been a hodge-podge of stop-gaps and fiscal rescuing of state and local authorities. Congress and the White House (no matter who has controlled either) have played an ever more political game of tennis with the budgets for Ryan White care and treatment funds, CDC prevention efforts and other elements, while state and territorial AIDS directors have struggled and screamed to be heard above the din of their 50+ colleagues. Presidents, Senators, and House chairmen have taken turns grandstanding, pointing fingers, and putting their heads in the sand -- and as a result, no one has been held accountable for the worsening problems at ground level. Worse yet, since the beginning, the swiss-cheese of federal HIV/AIDS policy has been the stage upon which the left and the right have pushed their nonsensical ideological agendas, often stepping over the bodies of the dead and dying to grab the microphone and show their utter disregard for science, public health and civic duty.

Enough already. If this election is supposed to be about change or reform, then let's hear it. And let's really demand it on AIDS, as gays of all political stripes. Obama or McCain (or both) must be pushed to propose some radical reforms on how the federal government deals with this issue.

We need a national HIV/AIDS strategy, with specific goals and targets, driven from the executive branch and ratified by the Congress. We need a national AIDS director who proposes this policy, carries it out, reports directly to the Secretary of Health and Human Services with budget authority, testifies to Congress, and is held accountable for its results. No more ceremonial offices on Lafayette Square or in the White House, which have too often served only as a political shop since the beginning. Real policy responsibilities, on a real timetable, and real accountability.

And Congress must be held to account as well. This idea that one or the other is the "better" party on AIDS is now shown for the charade that it is. The Republicans have been the ones who delivered on funding and reforms far and above the Democrats before or after them, but they've also been playing ideological and religious politics with AIDS since the beginning, from gay-bashing in the early days to ineffective abstinence-only and absurd anti-condom prevention requirements today, at the expense of people's lives. The Democrats have been long on sweet words and militant political support against discrimination (with the exception of visa policy, in which they failed miserably and were cowards until finally rectifying it this year), but have also been shamelessly provincial on funding formulas and naggingly resistent to now-desperately needed reforms in the system.

Finally, we need to heed the growing clamor from the CDC and adopt routine HIV testing in every state and territory. CDC director Julie Gerberding has been crying out in the dark to both her own administration and to Congress on this for too long. Her agency published recommendations, and then guidelines, years ago which call for making HIV testing with informed consent a routine part of medical care for all Americans aged 13 to 65, but no one is heeding it because she has no authority to mandate it. All of the science shows that it is the only way to close the gap among that huge number of Americans who are not aware of their status. Without it, we cannot prevent new infections from this population and we cannot move them into treatment. Two separate studies, one from Harvard and Yale, the other from Stanford, showed that routine testing would be as cost-effective as blood pressure checks have been. It's barbaric that we've just sit by and let these new statistics just happen even though we've known for years that routine testing could have helped prevent them.

In the end, my vote will be much more influenced by whether either candidate shows a real comprehension of the emergency we're facing at the federal level on HIV/AIDS, than by their positions on the apparently comatose ENDA or hate crimes bills. And not just lovely talk, or great big hugs, but real understanding of the sweeping reform that is necessary.

August 27, 2008

Posted by: Chris

Those looking to Barack Obama's vice presidential pick for some reassurance that the presidential nominee's strongly supportive gay rights talk will translate into legislative walk once in office will find little of either in running mate Joe Biden, the longtime Delaware senator.

The selection of Biden was immediately praised by gay and trans groups in Washington and by activists from his home state, but the good senator's record doesn't live up to such laudatory rhetoric. In fact, Joe Biden was without question dead last on issues important to LGBT voters among the eight Democrats who ran for president this year.

As usual, the Human Rights Campaign did the Democratic Party's bidding, "hailing" Biden as "a proven and effective advocate for fairness and equality," according to HRC president Joe Solmonese, whose "support and understanding has been unwavering."

"Unwavering"? HRC's own congressional report cards tell a very different story. Biden scored "unwavering" (i.e. "100") only one time in the decade, and has trended downward in recent years, from 89 ('97-'98), 86 ('99-'00), 100 ('01-'02) to 63 ('03-'04), and 78 ('05-'06). Do you know any parents or teachers who would look at report cards like that and pronounce those grades an "unwavering" success?

Neither Biden nor Obama supports same-sex marriage, of course, but Biden's opposition runs much deeper and is much more troubling. Obama opposed the passage of the notorious Defense of Marriage Act, as did John Kerry, the Democratic presidential nominee four years ago. Not Joe Biden. He sided with Republicans to enact DOMA into law, and has never once said publicly that he regrets his vote or favors a full or even partial repeal.

Biden's position on DOMA and other important issues remains a mystery in part because he was one of only two Democratic presidential hopefuls who chose to skip last fall's televised forum on gay issues sponsored by HRC and Logo. He claimed to have a "scheduling conflict" but his campaign website showed no appearances scheduled for the day of the forum.

Rather than consider that poor choice an example of "wavering," Solmonese points to the recent repeal of the discriminatory HIV travel and immigration ban as proof of "the type of leadership we can expect from Senator Biden on the issues important to our community."

Let's hope not. Solmonese credits Biden's work as chairman of the Senate Foreign Relations Committee as important to passage of the repeal, but really it was the least that Biden could do. After all, he was one of those who voted in favor of the original Helms Amendment back in 1988 that put HIV on the list of communicable diseases that could get you barred from entering the country.

When Louis Sullivan, the health secretary under Republican President George H.W. Bush, tried to take HIV off the list back in 1992, Joe Biden was one of only a handful of Democrats who broke ranks to support a Republican amendment that made the ban on HIV tourists and immigrants a matter of statute.

The "wavering" doesn't stop there, on either HIV or immigration. Biden has declined to date to sponsor the Early Treatment for HIV Act, which would allow states to use Medicaid money to help low-income folks who have HIV but not full-blown AIDS. When HRC asked the Democrats running for president to say "yes" or "no" about whether they support the bill, Biden was alone among the eight in dodging the question.

On immigration, Biden has not only declined to co-sponsor the Uniting American Familes Act, legislation that extends to gay Americans the right to sponsor foreign partners for citizenship, his only public statement on the issue is so vague that's impossible to tell for sure which way he'd "waver" if it came to a vote.

Mara Keisling, who heads up the National Center for Transgender Equality, also cut Biden a whole lot of slack, saying: "We have reason to think he's very positive on all LGBT
issues."

"All LGBT issues"? The Delaware senator was very, very late among Democratic senators to co-sponsor the Employment Non-Discrimination Act, back when it only protected "sexual orientation." Biden waited more than five years after ENDA was first introduced and finally signed on only after some thirty-four of his party colleagues -- and even three Republicans! -- had already done so. Is this the "leadership" HRC says "our entire community can be proud of"?

The HRC candidate questionnaire asked each of the Democrats running for president if they would "support and work for passage" of the new version of ENDA that prohibits protects both "sexual orientation and gender identity," Biden responded only that he supports outlawing bias based on sexual orientation, making him one of only two candidates to dodge the question.

Despite a lot of lazy fact-gathering on the blogosphere, there’s no clear evidence Biden favors adding transgender protections to ENDA. Aren't we supposed to care about that?

None of this is to suggest that Biden is actually anti-gay or has a record anything comparable to John McCain, the Republican presidential nominee, who is a gay rights nightmare. Biden has voted in favor of gay workplace rights, hate crime laws, against a federal marriage amendment and is solid on repealing "Don't Ask, Don't Tell." He's even said some encouraging things on the campaign trail about civil unions and the inevitability of gay marriage.

But LGBT voters deserve to know that the real Joe Biden bears little resemblance to the steadfast champion portrayed by the groups in Washington that supposedly advocate for our equality. If they've "pinkwashed" his record simply because an Obama-Biden administration would be far and away superior to a McCain-[fill in the blank] administration, then fair enough -- say so.

Don't mislead gay voters by lying about Biden's mediocre record because it only signals to Democrats (yet again) that something way less than a full loaf of equality will keep our stomachs from grumbling.

Maybe if Ted Kennedy had introduced the amendment, then yes. The spirit of "reconciliation" would perhaps be given the right air, and the right floor speech. And given Kennedy's emotional return to the Senate in order to cast a vote he felt he couldn't miss, it seems even in the realm of the possible that he could endorse this amendment and change my mind.

But no other gesture should convince the Senate to profane that important legislation with the name of Jesse Helms. It's like adding Bill Clinton's name to a sexual harassment bill -- it's just unacceptable and insulting no matter how contrite he may have said he was. Because we don't believe him.

***UPDATE:I just learned that Senator Jeff Sessions (R-AL) has dropped his effort to remove the amendment to lift the HIV travel ban that was added to the bill. This means that barring something completely unforeseen, the Senate will pass PEPFAR including the lifting of the ban. Then, it must survive a House-Senate conference and final passage, but all reports are that the House has already agreed to including the measure, and the White House also supports it. Perhaps we should rename the amendment repealing the HIV travel ban after Jesse Helms instead. Any takers?

July 04, 2008

Posted by: Andoni

I’m in Yosemite National Park, but just learned that former North Carolina Senator Jesse Helms has died at the age of 86. I am not sad.

Helms did more damage to the gay rights movement than any other single person I can think of in the Senate. One particular piece of legislation Helms is responsible for is his infamous HIV travel ban, known as the "Helms Amendment" which outlawed people with HIV from visiting the United States or immigrating to the United States. The U.S. is now one of only 13 nations including Iraq, China, Saudi Arabia and Sudan that ban HIV positive visitors and immigrants. That law, however, is on its last legs because a Senate panel just approved a move to repeal it.

I think a great way for all LGBT people to “honor” Jesse Helms at this moment is to make sure that this law is repealed. We cannot allow a pause due to reflection or “respect.” So call your Congressmen and Senators and tell them that the HIV ban must go and you support the PEPFAR legislation which removes the HIV travel and immigration ban. We need to make sure that Helms’ death accelerates this repeal rather than slows it down.

June 27, 2008

Posted by: Kevin

Today is National HIV Testing Day in the United States. It's an annual opportunity to focus on the fact that as many as 300,000 Americans are HIV-positive and don't know it. That's between 25% and 30% of the total number of people with HIV in America. They are undiagnosed, and therefore they are not in treatment and more likely to die of AIDS.

And it seems the American people are not blind to this reality. The Test for Life campaign last night released a poll, conducted by Peter Brodnitz, Barack Obama's presidential campaign pollster, which has some interesting results: 88% of likely voters believe that HIV and AIDS are still "a serious problem" in the United States, and 43% - a plurality of respondents - perceive that it has gotten worse over the last decade.

What's more, 65% of likely voters support making HIV testing a routine part of medical care, rather than something that Americans must skulk off to an anonymous clinic to have done. This is a highly important result because the U.S. Centers for Disease Control issued guidelines way back in 2003, then made them into recommendations in 2006, which called for HIV testing to become a routine procedure for Americans between the ages of 13 and 64, as an immediate measure to close this gap of people unaware of their status, and therefore not getting treatment and infecting others.

The medical profession has resisted or ignored the guidelines for too long, but state and local governments are finally realizing they have no choice. The high number of people, mostly men of color, receiving late diagnoses and entering treatment after the onset of AIDS, reflects a total failure in our national AIDS strategy. Routine testing has been the missing element. In New York City, the Bronx has decided it must find every way possible to ensure that every adult in the borough gets tested within the next three years.

Even First Lady Laura Bush says that HIV-related stigma must be ended, and that it is imperative that every American get tested for HIV. Barack Obama himself got a public HIV test when he visited Kenya. President Bush's global HIV/AIDS relief program (PEPFAR) is awaiting approval in Congress, and the new program will massively increase the amount of money for fighting the disease abroad. There is never enough funding for each community's needs here at home when it comes to the myriad of problems that AIDS causes around us.

But nothing would be more powerful than you, yourself, marching down to your doctor's office or the local clinic and getting an HIV test today, this weekend, or next week. Knowing the truth could save your life, and the lives of others. HIV is only a death sentence if you want too long to find out.

January 19, 2008

Posted by: Chris

The Associated Press has an incredibly one-sided report out quoting public health experts who question whether too much money is being spent on HIV/AIDS globally in proportion with basic health problems like sanitation, malnutrition and clean water that are responsible for more deaths annually:

"We have a system in public health where the loudest voice gets the most money," said Dr. Richard Horton, editor of Lancet. "AIDS has grossly distorted our limited budget."

This is the same old saw we've heard for years, of course, although in the past its proponents were anti-gay conservatives whose compassion is limited to one sexual orientation. Now the doctors and researchers who have benefited from billions (spent far too late in the epidemic) are lobbying for more funds to deal with other health problems. No issue there but it's wrong to take from Peter to give to Paul.

Unlike these other basic health problems, HIV/AIDS is an incurable epidemic already responsible for killing millions and infecting tens of millions more. The nature of the virus and the cost of adequate treatment mean it poses a health threat out of proportion to the number of its victims.

December 28, 2007

Posted by: Chris

There's a valuable lesson to be learned in the welcome news today that President Bush signed a bill that allows the District of Columbia to use its own money to fund needle exchange programs in the fight against HIV/AIDS. Besides the obvious -- that it takes Washington about as long as the Vatican to accept inconvenient scientific facts -- there is also a glimpse of what we can expect if Hillary Clinton manages to become the next president.

Ben Smith at Politico.com noted a month ago that Hillary's campaign proposal for HIV/AIDS policy included federal funding for needle exchange, a policy reversal for her and her husband:

The changed position is worth pausing over because needle exchange was the subject of one of the campaign's most illuminating moments, during a New York City event at which an AIDS activist, Charlie King, pressed Clinton on her husband's rejection of recommendations that the federal government back needle exchange programs. I wrote about the exchange, which was caught on video, in July.

"Well, because we knew we couldn't maintain it politically," Clinton said, and went on to discuss the trade-offs in that dispute with Congress. "I wish life and politics were easier," she said.

King then referred back to Clinton's opening remarks. "You made a great comment earlier about how our next president needs to have some spine," he said.

"We’ll have as much spine as we possibly can, under the circumstances," Clinton responded.

That's classic Hillary: "We'll have as much spine as we possibly can, under the circumstances." It's actually classic Clinton, applying to either Bill or Hillary. And it's exactly why her husband was such a dramatic disappointment on gay issues -- and needle exchange -- as president. Bill Clinton had the opportunity in 1998 to approve federal funding for needle exchange, but instead accepted the recommendation against funding from his conservative Drug Czar, Barry Cafferty.

Four years later, attending an AIDS conference as the former president, Bill Clinton said he regretted how he handled needle exchange, but notice how closely the language -- and the thinking -- tracks that of his wife:

Asked about what he had done to fight AIDS as president, Clinton said: "Do I wish I could have done more? Yes, but I do not know that I could have done it."

In particular, he cited his stance on needle-exchange programs, saying, "I think I was wrong about that; I should have tried harder to do that."

He was referring to his administration's refusal in 1998, after a bitter internal debate, to lift a longstanding ban on federal financing for programs to distribute clean needles to drug addicts, even as top government scientists said such programs did not encourage druge abuse and could save lives. At the time, Clinton's advisers said they feared a political disaster for him if he lifted the ban.

Even acknowledging his error, Bill Clinton was saying the same as Hillary did, that he showed "as much spine as he possibly could, under the circumstances." The real issue -- with him then as with her today -- is whether a Clinton president will risk political capital and show leadership on important social issues.

Witness Bill Clinton on gay issues: He caved on "Don't Ask, Don't Tell" and never lifted a finger on the Defense of Marriage Act -- except to sign it into law. The same "under the circumstances" spinelessness caused him to cave on needle exchange, as the late Bob Hattoy, an openly gay and HIV-positive official in Clinton's Interior Department, said back in 1998 in an interview with Southern Voice:

"This is worse than 'Don't Ask, Don't Tell' because instead of just ruining lives, it can actually kill people. The president was either ill-advised or he decided certain Americans with HIV can just die. This is a very sad day for a president who wanted to have any kind of moral authority."

Expect more of the same from Hillary Clinton; she even signals as much. Some five years after her husband acknowledged that he erred in not fighting for needle exchange funding, Hillary was still too cautious and calculating to acknowledge as much.

Now that she's finally come around on needle exchange, no doubt because primary opponents Barack Obama and John Edwards favor federal funding, the whole timeline shows what Ben Smith called her philosophy of governing: "You can call [it] pragmatism and readiness; or too much caution, too little vision. Certainly, Hillary seems to lack Obama's confidence in the ability of a President to shape public opinion, and to lead against it."

On gay rights, that means Hillary would sign the easy stuff -- hate crimes and employment non-discrimination, and maybe even a repeal of "Don't Ask, Don't Tell" -- but don't except anything else from a Clinton II presidency -- whether one or two terms -- unless absolutely no leadership or political risk is required.

November 30, 2007

Posted by: Chris

I posted earlier this week about a convincing trove of data showing that HIV is again spreading in larger numbers among gay and bisexual men, in the U.S. and abroad. The question remains what we -- the government, HIV/AIDS group and we gay and bi men -- are going to do about it.

Since tomorrow is World AIDS Day, there's no better time to make a few informed suggestions.

One thing is clear: The old ideas of the past, simply handing out condoms and such, are no longer working. It’s time for new ideas and new energy. If anything, the data on rising HIV infections is an indictment of the way most agencies have tackled prevention among gay and bisexual men.

For one thing, it’s long past time to trust gay and bisexual men with real information about the risk of exposure associated with particular sexual behavior. It’s criminal that more than a quarter-century into this epidemic, public health officials still keep secret the data they have on the relative risk associated with giving or receiving oral and anal sex, with and without condoms.

Armed with the better information, people will act more responsibly than they are today under the "use a condom every time" reminder. That's not to say that condoms should be abandoned. Agencies should rediscover effective marketing techniques to remind gay and bi men where they meet -- bars, clubs and online chat rooms -- to wrap it up. The TV ad I posted about a couple of days ago, produced by the government of Brazil, is an example of the kind of frankness that gets noticed.

But it’s not just about condoms. Gay men are already way out ahead of prevention efforts, adopting their own techniques like “sero-sorting” – that is, poz men having sex with only other poz men – to limit if not eliminate their exposure. We need to know what works and what doesn’t.

One thing we know works is getting tested, since men who know they're positive take meds, which makes them less contagious, and are less likely to engage in risky sexual behavior.

The JAMA report also makes one policy argument that is long overdue. The authors called for “legal domestic partnerships as a way to promote stable, longer term [gay male] relationships.” The most effective curb against gay male sexual promiscuity is to encourage committed relationships, and legal recognition is an important way of doing that.

Another is for public and private HIV agencies to help promote the alternative of dating and relationships over promiscuity; not in a preachy way, but by reminding us all how sex with love beats just plain sex any day. The Brazilian TV ad, in which parents counsel their son to take a condom on a date with his boyfriend, is another subtle example of that.

I would go one step further, and develop marketing campaigns that remind us all that good old-fashioned dating, going steady and relationships have a lot to recommend them, especially with rising HIV statistics. Most of the gay men I know who survived the worst of the AIDS slaughter in the 1980s and 90s did so because they were in relationships. There's nothing wrong -- and a lot right even beyond the safe sex context -- to remembering that lesson.

November 29, 2007

Posted by: Chris

In recognition of World AIDS Day, the Brazilian government has produced a series of safe-sex advertisements that are running on television. There's even one with a refreshingly positive message for young gay men.

Son: I'm heading out...Dad: Be careful.Mom: Don't forget to take a condom.Dad: Son, take it just in case. You never know if your boyfriend is going to have one or not.Son: Thanks Dad, thanks Mom.Negra Li: You don't expect all parents to be like this, right? Wearing
a condom should be your attitude, and it is important in the fight
against AIDS.

The spokesperson at the end of the spot is singer Negra Li. If only our government would invest in messages like this, or our TV networks would even air World AIDS Day messages like this in primetime. So much for our leadership role in the global fight against AIDS.

November 28, 2007

Posted by: Chris

Just in time for Dec. 1, World AIDS Day, there is bad news about rising HIV infection rates among gay and bisexual men, in the United States and beyond. Don’t turn the page just yet. This isn’t yet another alert about yet more “alarming” HIV rates or a dire warning about a “second wave” of infections.

They may not have come up with a vaccine to make us immune from HIV, but we’re almost completely immune to these repeated cries of AIDS “wolf.” Too many cogs in the AIDS, Inc. machine – from pharmaceutical companies, HIV organizations and politicians hording government AIDS dollars – have a self-interest in promoting “alarming” data on the epidemic. So we tune them out almost instinctively.

This time, however, is different. It’s not one study; it’s many, and they all show an undeniable increase in HIV infections among men who have sex with men:

The rate of new infections among gay men under 30 in New York City rose 33 percent from 2001 to 2006.

As many as 1 in 22 gay and bi men in Florida is infected, with rates reaching 1 in 11 gay white men in Fort Lauderdale, 1 in 13 gay black men in Palm Beach and 1 in 12 gay Latinos in Miami-Dade.

New infections among gay and bi men in the U.K. are at record levels, with an estimated 1 in 20 infected nationwide and 1 in 10 in London.

In Australia, HIV infection rates have risen by a third in the last decade, with 88 percent of transmissions occurring through gay sex.

Then came the big one: a report this week in the Journal of the American Medical Association showing that overall, the number of gay and bisexual men in the U.S. with HIV or AIDS has risen 13 percent in just the last four years.

The authors of the JAMA report put a lot of the blame for that increase on the fact that most of us don’t know our HIV status. One study cited in the report found some 77 percent of the gay and bi men infected with HIV were unaware they were positive; 91 percent of black gay and bi men did not know they were infected.

The report also pointed to another cause that anyone who’s sexually active already knows intuitively: Sex without condoms has become more and more common, especially among young gay guys, as rebounding rates of syphilis among gay and bi men also testify.

The reasons are also no mystery. Most sexually active gay and bisexual men weren’t around for the darkest days of the AIDS epidemic, never cared for dying lovers and friends and didn’t attend funeral after funeral for men cut down before they turned 30.

The drug cocktail has transformed AIDS into a treatable, if not curable, disease, and the conservative political climate has diverted too much funding into abstinence at the expense of safe sex prevention efforts.

The rising infection rates will undoubtedly result in calls for additional funding for HIV/AIDS prevention, and no doubt those additional dollars are needed. But the grab for cash ought to be coupled with a hard look at whether we’re throwing good money after bad.

December 17, 2006

Posted by: Chris

Watching politicians when you feel like your civil rights depend on it can feel like an exercise in courting frustration. Just like the lonely single always expecting happiness from the next date, the would-be courtier almost inevitably disappoints. But since the "prize" is so important, you keep your eyes on it, and the next suitor in waiting. Along the way, you try to walk the line between hopeful skeptic and jaded and bitter.

That's how I felt reading all the positive press about Barack Obama's triumphant appearance in the belly of the beast, winning a standing ovation from the conservative congregation at Saddleback Church in Orange County, Calif., home to anti-gay, pro-life evangelist Rick "Purpose-Driven Life" Warren. "Pastor Rick" cheerfully withshood a mini-rebellion from other conservatives for even inviting pro-gay, pro-choice Obama to speak at a special World AIDS Day service.

Obama delivered with an address that interwove the Illinois senator's religious conviction in a natural way that the John Kerrys and Howard Deans — much less the Hillary Clintons — can only dream of. Liberal pundits cheered and the Obama "boomlet" sounded again. So why did I hear a bit of a thud?

In many ways, Obama's address at Saddleback hit all the right notes, expanding the idea of religious activism beyond legislating conservative theological positions, Taliban-style. His stories about AIDS in Africa were poignant and his call to action effective. But below the surface… we Chandler-Seinfelds of the gay political world saw signs that Obama might be another Bill in Clinton's clothing — the man from a place called Hope, who promised we didn't have a person to waste, whose view of America included us, and who went on to sign the two worst pieces of anti-gay legislation in U.S. history: Don't Ask, Don't Tell and the Defense of Marriage Act.

Many of those signals in Obama's address were in the tone, especially in how every time he referred to sex in relation to AIDS, whether in Africa or in the U.S., he referred to the relationship between "men and women":

For some, the only way to prevent the disease is for men and women to change their sexual behavior…

I don't think we can deny that there is a moral and spiritual component to prevention — that in too many places all over the world where AIDS is prevalent — including our own country, by the way - the relationship between men and women, between sexuality and spirituality, has broken down, and needs to be repaired.

[In Africa], I heard stories of men and women contracting HIV because sex was no longer part of a sacred covenant.

I also believe that we cannot ignore that abstinence and fidelity may too often be the ideal and not the reality — that we are dealing with flesh and blood men and women and not abstractions.

It wasn't that Obama was off the mark in the substance of what he was saying in any of those snippets, or generally, and he was speaking about AIDS in Africa on World AIDS Day — both of which generally concern a virus transmitted heterosexually. But like a scorned spinster trying to stay hopeful on a date going south, I found myself bracing a bit more each time, waiting for the other shoe to drop. And then, with a thud, it it did:

Like no other illness, AIDS tests our ability to put ourselves in someone else's shoes — to empathize with the plight of our fellow man. While most would agree that the AIDS orphan or the transfusion victim or the wronged wife contracted the disease through no fault of their own, it has too often been easy for some to point to the unfaithful husband or the promiscuous youth or the gay man and say "This is your fault. You have sinned." I don't think that's a satisfactory response. My faith reminds me that we all are sinners.

Ouch. There we are, down there in the muck with the unfaithful husband and the promiscuous youth. And our man Obama is there for us, reminding everyone that they sin as well. Of course, they generally don't organize a civil rights movement asking for legal recognition of their sins, or hold annual festivals to celebrate their pride in being sinners.

Sp what to do with Obama, who has a strong gay rights record, if not one that shows much leadership, though like almost all serious possible Democratic contenders for the White House in '08, he opposes gay marriage? We keep an eye on him, and on the prize, and hope he doesn't follow Dean and other Dems in some quixotic quest to woo the right. For once, we should insist to dance with the ones we help bring.

December 14, 2006

Posted by: Chris

Two clinical trials have been halted midstream after it became clear that circumcision reduced by at least half a man's risk of contracting the AIDS virus, at least in heterosexual sex. Officials with the U.S. National Institutes of Health stopped the trials, in Kenya and Uganda, after learning that more than twice the number of uncircumcised men had contracted HIV than in a similar sized circumscribed group. The New York Times reports:

Uncircumcised men are thought to be more susceptible because the underside of the foreskin is rich in Langerhans cells, sentinel cells of the immune system, which attach easily to the human immunodeficiency virus, which causes AIDS. The foreskin also often suffers small tears during intercourse.

The protection offered by circumcision in anal sex is murkier. Anthony Fauci, the famous AIDS researcher and director of the NIH's National Institute of Allergy & Infectious Diseases, told the Times that circumcision "does nothing to prevent spread by anal sex." But a Q&A fact sheet provided by Fauci's agency indicates, "The degree of protection that circumcision may afford for men who have sex with men is unknown." Still, even if circumcision helps protect the active partner (the "top") in homosexual anal sex, the effect will be at the margins, at least in the U.S., where 77 percent of men are already circumcised.

The new NIH study confirms findings from an earlier South African study that concluded circumcised men were 65 percent less likely to contract HIV from vaginal sex than those whose penises are uncut. Francois Venter, a South African AIDS expert at the University of Witwatersrand, made headlines in September 2005 by comparing the effectiveness of circumcision to that of a vaccine.

"We dream of a vaccine which has this efficacy," Venter said then. Indeed, most "AIDS vaccines" that have been approved for any level of clinical trial never even claim to achieve protection in as many as 65 percent of those "vaccinated." Still, Venter's use of the vaccine comparison was roundly criticized for suggesting circumcision provided complete protection. That's a dangerous suggestion, especially considering that it only improves protection odds for men, not women, although women would be indirectly benefited by a decrease in the number of infected men generally.

Played out on a scale of millions, circumcision would no doubt save many lives, especially if the expanded use of microbicides provide anything like the level of protection for women that scientists hope. There are clear scientific reasons why heterosexual, vaginal sex is more easily made safer, since anal sex invariably involves more tissue breakage, both because the anal opening is smaller and the receptive tissue is much more sensitive and thin.

But rest assured that some opportunistic religious leaders will nonetheless leap to moral conclusions about what sex is "natural" or sinful. (Also rest assured, believe it or not, that anti-circumcision groups, often led by gay men, will recklessly try to debunk the new science as encouraging what they call "male genital mutilation.")

It's not difficult to imagine, over the next five to 10 years, that circumcision and microbicides dramatically reduce the risk of HIV infection from heterosexual sex, making anal sex and I.V. drug use again the most prevalent forms of transmission worldwide. We'll see if the AIDS, Inc., industry continues pressing for ways to make homosexual sex just as safe. You can certainly imagine that a grant request with that as a stated goal is much less likely to get government funding.

November 30, 2006

Posted by: Chris

Tomorrow, December 1, is World AIDS Day, and a good opportunity to remind ourselves that the virus is still out there, still spreading, still incurable and still killing — even here in the U.S. Americans have been inundated in recent years with mostly good news about new HIV treatments, while the bad news about the spreading virus and death tolls are "global AIDS" stories, in faraway places like Africa and Asia.

If the mainstream media — and many gay press outlets — would only pay attention, there are plenty of story threads to cover about HIV/AIDS in the U.S.:

The stubbornly high rates of infection among African Americans, fueled by homophobia within black culture and the church, that keeps so many gay black men into the closet (call it "the down low" or not), putting at risk themselves and their male sex partners, girlfriends and wives. The media has sensationalized "the D.L." without ever really delving into its roots in the culture and the church — the same types of sources, of course, that keep white gay men in the closet, too.

The uneven success of HIV meds, which have not cured the disease and, according to recent reserach, only extended the life expectancy — diagnosis to death — from 7 years to 24. And there's no "holiday" from HIV. The first large-scale study on taking "breaks" from HIV meds shows the risk of death doubling, even though the cause of death isn't necessarily AIDS-related. (One caveat: the study, which concludes patients should stay on a daily med regimen their whole lives, was partially funded by pharmaceutical companies.)

The Bush administration's unconscionable elevation of idelogy over science in pushing "abstinence-only-until-marriage" as a viable HIV prevention strategy. Abstinence has a role to play in prevention, especially among young people who can be encouraged to delay an active sex life. As part of the ABC's— Abstinence, Be Faithful, Condoms — is a proven effective approach. But "abstinence-only-until-marriage" ignores reality and, given opposition to gay marriage, is irrelevant to the lives of young gay men, who remain a very high risk group. It's irresponsibility is second only to the Vatican's morally reprehensible opposition to condom use, even among heterosexual married couples with one spouse who is poz and one who is neg.

The death of AIDS activism in the U.S. The virus wiped out a generation of gay men and the organizations they started are now largely run by non-profit professionals who no doubt care about the issue but act as if their fiduciary responsibility is to their board of directors and not to those living with the disease or at risk of being infected by it. Only a miniscule percentage of those board members are even HIV-positive. Co-opted by fat checks from the government and a decline in private donations, many HIV/AIDS groups have lost their critical voice like the ones raised above. When is the last time you saw a new, provocative, effective prevention message from an HIV/AIDS group in the U.S.? When was the last time you saw them publicly criticizing the Bush administration's response to the epidemic?

What can you do? We all have a duty to stay informed and make sure our friends, family and those within our zone of influence, stay informed as well. Be careful that your AIDS donations go to groups that still have an effective message and responsible management.

And finally, one small thing you can, is visit LightToUnite.org, an interesting site that allows you to read stories of those impacted by HIV and add your own. And Bristol-Myers, the big pharmaceutical that sponsors the site, will donate $1 for every person who visits. Be sure to add your own story, and make clear if the folks involved are gay. I read three-dozen accounts before coming across the first one that dealt with the issue openly, and it was a woman writing about her boyfriend's "homosexual "brother. Pretty scary in 2006, if that's all the representation we've got, but another of how the virus has mainstreamed.

November 24, 2006

Posted by: Chris

I got a few reminders over the holiday yesterday about how we gay men make our own families, whether or not we're in relationships. I spent the day in Washington, thousands of miles from my partner in Brazil. Although Thanksgiving of course has no special meaning for him, he sent me a sweet online card and we talked several times by Internet telephone (we give thanks to Skype!).

During one stretch of afternoon, I drifted off into a daydream, one I've had many times before, of him here with me, maybe smuggled in my suitcase. I know how silly that sounds, but the subconscious takes its own course.

I was reminded of that fantasy later, as I watched the closing scene from "Longtime Companion." I found the film on my TiVo, recorded a year earlier, and had decided to see it (for the first time).

Released in 1990, "Longtime Companion" was one of the first "AIDS movies," and it effectively drew you back to the fear and loss that filled the decade of the 1980s for gay men. At the end, when the original group of seven friends has dwindled to three, they imagine what it would be like if a cure for the virus was discovered, and they could celebrate with all their lost friends. As silly as it sounds, it is a devastating scene. I defy you to watch it without tears.

These men created a family of friends, boyfriends and partners — longtime companions, as the New York Times deigned to refer to them in obituaries — and they stuck by each other as blood families do. Some were still supported by blood relatives, others were turned away, but as the character Willy (Campbell Scott) describes in a memorial service for his friend David (Bruce Davison), their friendship circles were welcoming and unshakeable.

AIDS is still with us, of course, and still kills. I learned this month that Dennis Vercher, the longtime editor of the Dallas Voice, recently passed away from complications from the virus. He was only 53. But even without the trauma of weekly memorial services, there's still evidence of how we make our families. I counted a half-dozen "orphan" dinners for Thanksgiving yesterday, just among the folks I know. These meals are usually hosted by a close set of friends that then widen their net, inviting anyone and everyone unable or not wanting to return home to see family for the holiday.

With so many lost to AIDS and the advent of new drugs, the disease and a united response to it are not so ingrained into the consciousness of those who came out in the last five to 10 years. That's a good thing, of course, because no generation should have to endure such horror, whether from epidemic or war. But these wonderful "orphan meals" on Thanksgiving and Christmas are a welcome reminder of how much we gain from our opening up our circle of friends, our chosen families, to the larger community.

November 17, 2006

Posted by: Chris

When I came out in 1992, a diagnosis of HIV was a death sentence. In those very dark years, there was no drug "cocktail" and the gay papers will chock full of sometimes dozens of obituaries each week — men in the 30s and 40s, struck down in their prime. At the time, with so many dying and turning positive, I remember imagining that I would probably live another 10 to 15 years before the virus would catch up with me and kill me, too.

Now an American can expect to live on average 24 years from the time he learns he's been infected with HIV, according to new research. That's a dramatic increase from 7-10 years from diagnosis to death in the '90s. The new drugs have a new pricetag, of course, as the average cost of care has skyrocketed to $25,200 per year, or more than $600,000 over a lifetime. That explains why the longer life expectancy is good news limited to First World countries and those with health insurance, public or private.

But despite the upbeat tone from researchers, my reaction was negative shock. We have become so accustomed to thinking of HIV as a manageable, chronic condition that we forget it's still a killer. In fact, the new drugs aren't a cure and can be lethal themselves. Despite all the advances, someone diagnosed with HIV is still likely to die of complications associated with the virus or the meds they're taking to fight it. A 21-year-old who learns he has HIV can expect to die in his mid-40s.
That's a message that's not getting out there.

Under George W. Bush, HIV prevention has morphed from a public campaign on safer sex to an emphasis on abstinence and making HIV testing routine and universal. Both policy corrections were needed, although abstinence taught as anything more than a way to delay sex for teens can and does backfire. But universal testing, as nervous as it's made HIV/AIDS groups, is critical to stopping the virus. People who know they're infected are not only more likely to start treatment, but they're more likely to have safe sex, or limit their unsafe sex to other poz people, and that should slow the spread.

Even still, today's "good" news is a reminder that there's still a place for powerful public campaigns that remind people that HIV is out there, and it's still deadly. The Europeans have always done a better job on that.

Thousands quit smoking every year because they're afraid of dying early from lung cancer. Unsafe sex can have the same consequence, with a much shorter fuse and a world of complications along the way. Twenty-four years is great, but it's not a cure.